Laparoscopic surgery, or minimally invasive surgery, has replaced many standard invasive abdominal operations that require large incisions. Current laparoscopic surgical techniques include the creation of small incisions in the lateral abdominal wall, into which one or more surgical trocar assemblies or other similar puncturing devices are placed. A trocar assembly is typically comprised of an obturator having a puncturing distal end, and a sheath or cannula which is adapted to slide over the outer diameter of the obturator. The obturator and cannula are typically used together to puncture the lateral abdominal wall to gain access to the surgical site. Once the puncture is made, the obturator is removed from the hollow cannula creating a port for introducing and removing various surgical instruments. Scissors, dissectors, retractors, and biopsy instruments can be manipulated through a plurality of surgically placed ports, together with viewing devices such as endoscopes or laparoscopes, to perform surgery or diagnostic procedures. The intraperitoneal space is typically insufflated with pressurized carbon dioxide to provide more room and better exposure for viewing the anatomy and manipulating the instruments through the ports. This technology affords the patient considerably less pain and disfigurement, and a much faster recovery.
Upon completion of the laparoscopic procedure, the remaining trocar wounds are preferably sutured to close the wound. Closure of these wounds requires proper identification and closure of the underlying abdominal wall layers of connective tissue and muscle. If these fascial layers are not properly aligned and sutured closed, bowel herniation at the port site (a “port site hernia”) can result, as well as the possibility of bowel strangulation or omental trapping. Because of the limited exposure provided by the very small size of the incision and the somewhat awkward, external access to the tissues surrounding the incision, proper closure of trocar wounds can be problematic and time consuming. Successful closure is also often further compromised by patient obesity and other factors.
When closing a lateral abdominal puncture wound the suturing needle should not only secure an optimal amount of tissue to prevent herniation but also avoid sensory and motor nerves present in the more superficial layers of the lateral abdominal wall. Specifically, the iliohypogastric, ilioinguinal and thoraco-abdominal nerves typically travel along a superficial fascial plane just beneath the internal oblique muscle, but not in the deeper layers that include the transversalis fascia, pre-peritoneal fat and the peritoneum. Thus, avoiding the more superficial layers of the lateral abdominal wall and passing the suture needle to close only the deeper fascial planes can avoid nerve entrapment or post-operative neuropathy, while still sufficiently closing the wound.
Current port site closure devices, such as that disclosed by U.S. Pat. No. 6,183,485 to Thomason et al. or U.S. Pat. No. 6,743,241 to Kerr, both of which are incorporated herein by reference in their entirety, close abdominal wall laparoscopic port sites via a “mass closure” device in order to prevent post-operative herniation. However, such mass closure devices use an approach in which the suture needle is passed indiscriminately and/or at an oblique angle through virtually all fascial layers of the lateral abdominal wall (see, e.g., FIG. 2, suture 32), which can lead to long term postoperative pain in the form of nerve entrapment, post-operative neuropathy and/or the need to surgically remove the suture.
While known abdominal wound closure devices may be useful for their intended purposes, it would be beneficial provide a wound closure device in which the suture needle avoids the superficial abdominal fascial layers containing nerves. There is also a need for an improved device and method for closing abdominal wound sites that can minimize the risk of nerve entrapment, post-operative neuropathy, puncture site herniation or other undesirable side effects of laparoscopic surgery. It would also be advantageous to provide a surgical device and method that can be utilized by surgeons having various skill levels.